In Prison My Mental Health Diagnosis Gave Me Access to Meds — Others Were Denied Care Entirely – Truthout

Report on Mental Healthcare Deficiencies in New York Correctional Facilities and Alignment with Sustainable Development Goals

Introduction: A System in Conflict with Global Health and Justice Standards

An examination of mental healthcare services within New York’s correctional system reveals significant deficiencies that are in direct opposition to key United Nations Sustainable Development Goals (SDGs). The current model, which predicates care on pre-existing documented diagnoses, fails to meet the standards of SDG 3 (Good Health and Well-being) and undermines the principles of SDG 16 (Peace, Justice and Strong Institutions). Testimonial evidence from incarcerated individuals indicates a system that prioritizes bureaucratic procedure over human health, resulting in widespread, unaddressed suffering and perpetuating cycles of trauma.

Systemic Barriers to Mental Health Services

The “File System”: A Driver of Inequality

The primary obstacle to care is an administrative policy that ties mental health services to an individual’s pre-incarceration medical file. This practice creates a significant barrier that is inconsistent with SDG 10 (Reduced Inequalities).

• Pre-existing Diagnosis Requirement: Access to the mental health caseload is largely dependent on having a documented psychiatric diagnosis prior to incarceration.
• Socioeconomic Disparity: This system inherently favors individuals who had the financial means and access to healthcare before their arrest, thereby discriminating against those from lower socioeconomic backgrounds.
• Invisible Suffering: Individuals who develop or manifest mental health conditions during incarceration, or who were previously undiagnosed, are systematically ignored, their conditions left untreated.

Inadequacy of Existing Care and Failure to Meet SDG 3

For the minority who do qualify for the mental health caseload, the services provided fall short of comprehensive treatment, failing to uphold Target 3.4 of SDG 3, which aims to promote mental health and well-being.

• Lack of Therapeutic Services: Treatment consists primarily of medication and monthly check-ins, with a near-total absence of substantive therapeutic interventions such as counseling, support groups, or trauma-informed therapy.
• Medication as a Control Mechanism: Medication is often presented as the sole solution, reducing complex human suffering to a matter of dosage and compliance rather than being part of a holistic healing process.
• Dismissive Institutional Culture: Mental health symptoms like depression and anxiety are frequently dismissed by staff as behavioral issues or attempts to manipulate the system, rather than being treated as legitimate medical conditions.

The Societal Cost of Institutional Neglect

The Trauma of Incarceration and Institutional Accountability

The correctional environment itself is a significant source of psychological trauma, a factor the current system fails to acknowledge or address. This neglect represents a failure of the state’s duty of care, a core tenet of SDG 16 (Peace, Justice and Strong Institutions).

• Psychological Harm: Research, including a 2023 study from Harvard’s Kennedy School, confirms that incarceration causes lasting psychological harm due to constant surveillance, violence, and loss of autonomy.
• Punitive vs. Therapeutic Response: Mental health crises are often treated as disciplinary infractions, leading to punitive measures like solitary confinement, which exacerbates psychological distress.
• Institutional Liability Evasion: By linking care to prior documentation, the institution effectively absolves itself of responsibility for the mental health deterioration of individuals under its supervision.

Statistical Disparities and Community Impact

The gap between the recognized need for mental healthcare and its provision has severe consequences that extend beyond prison walls, impacting recidivism and community well-being, which are linked to SDG 1 (No Poverty) and SDG 8 (Decent Work and Economic Growth).

• The Care Gap: While the New York State Department of Corrections and Community Supervision (DOCCS) reports 29% of its population is on the mental health caseload, the Bureau of Justice Statistics estimates nearly 50% of incarcerated people nationwide have a mental illness.
• Increased Recidivism: Releasing individuals with untreated mental health conditions increases the likelihood of reoffending, perpetuating cycles of poverty and undermining public safety.
• Community Burden: The failure to provide adequate care shifts the burden onto families and communities, who must manage the consequences of untreated trauma and mental illness.

Recommendations for Aligning Correctional Healthcare with Sustainable Development Goals

Policy and Procedural Reforms for a Health-Centered System

To align with global standards for health, justice, and equality, a fundamental overhaul of the mental healthcare system within correctional facilities is required. The following reforms are essential:

1. Implement Universal Screening: All individuals must receive comprehensive mental health screenings by independent clinicians upon intake and at regular intervals throughout their incarceration.
2. Provide Comprehensive and Accessible Care: Every facility must offer a full spectrum of mental health services, including talk therapy, group support, and specialized trauma-informed care, available to any individual in need, regardless of their prior medical history.
3. Mandate Staff Training: All correctional and medical staff must be trained to recognize signs of mental distress and respond with therapeutic interventions rather than punitive measures.
4. Acknowledge Incarceration as Trauma: The system must officially recognize the inherently traumatic nature of incarceration and integrate this understanding into all policies and treatment protocols.

Conclusion: An Imperative for Human-Centered Reform

The current mental healthcare framework in New York’s correctional facilities is a systemic failure that contravenes the principles of the Sustainable Development Goals. It perpetuates inequality (SDG 10), denies the right to health (SDG 3), and undermines the creation of just and effective institutions (SDG 16). Investing in a humane, accessible, and comprehensive mental healthcare system is not a matter of expense but a critical necessity for fostering individual rehabilitation, ensuring community safety, and fulfilling the global commitment to health and justice for all.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

1. SDG 3: Good Health and Well-being

   • The article’s central theme is the lack of mental health services for incarcerated individuals, which directly relates to ensuring healthy lives and promoting well-being for all. It describes how conditions like depression, anxiety, and PTSD are ignored and untreated within the prison system. The text states, “in New York’s jails and prisons, mental health services do not exist unless it is documented and part of your case file,” highlighting a systemic failure to provide essential healthcare.

2. SDG 10: Reduced Inequalities

   • The article exposes significant inequalities in access to healthcare based on an individual’s pre-incarceration socioeconomic status. The author notes, “That single privilege, the ability to afford care and obtain a documented diagnosis, became the reason I qualified for mental health care in jail.” This creates a two-tiered system where those who could afford a psychiatrist before prison receive care, while those who could not are denied it, regardless of their needs. This is a clear inequality of outcome based on economic status.

3. SDG 16: Peace, Justice and Strong Institutions

   • The article critiques the justice system (specifically the New York State Department of Corrections and Community Supervision – DOCCS) as an institution that is ineffective, unaccountable, and unjust in its treatment of people with mental health issues. It describes how the “file system does not merely fail people; it protects the institution” by allowing it to “shift responsibility away from itself” and “limit accountability.” The call for reforms like independent screenings and trauma-informed care is a call to build more effective and accountable institutions.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. Target 3.4: Promote mental health and well-being

   • This target aims to “reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.” The article directly addresses this by detailing the failure to treat mental illnesses like depression and anxiety. The author’s experience of being told “That is just the price you pay to feel better” after having thoughts of self-harm, and the mention of rising suicide rates, underscore the system’s failure to promote mental health and prevent premature death.

2. Target 3.8: Achieve universal health coverage

   • This target calls for “access to quality essential health-care services… for all.” The article demonstrates that universal health coverage is not being achieved within the prison system. The policy of requiring a pre-existing diagnosis denies essential mental healthcare to a significant portion of the incarcerated population. The author notes, “I watched men beg for help and get turned away because they lacked a formal diagnosis before incarceration,” which is the antithesis of universal coverage.

3. Target 10.3: Ensure equal opportunity and reduce inequalities of outcome

   • This target aims to “ensure equal opportunity and reduce inequalities of outcome, including by eliminating discriminatory… policies and practices.” The prison’s policy of tying care to prior documentation is a discriminatory practice that leads to unequal health outcomes. The article argues that this policy means an individual’s suffering “did not count because it was not already written down in a file,” creating a clear inequality in access to care and health outcomes.

4. Target 16.6: Develop effective, accountable and transparent institutions

   • The article critiques the prison system as an institution that lacks effectiveness and accountability. The author argues that the system’s policies are designed to “limit accountability, and allows lawmakers to say they are addressing mental health without making real investments.” The fact that “people leave prison more fragile than when they came in” and that untreated mental illness “drives higher recidivism rates” points to an ineffective institution.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

1. Gap in Mental Health Service Coverage

   • The article provides a direct statistical indicator of the failure to achieve universal health coverage (Target 3.8). It states, “DOCCS reports that about 29 percent of incarcerated individuals are currently on the mental health caseload… Yet according to the Bureau of Justice Statistics, nearly 50 percent of incarcerated people nationwide live with some form of mental illness.” This gap between the estimated need (50%) and the actual service provision (29%) is a quantifiable measure of the problem.

2. Suicide Rates

   • As an indicator for promoting mental health and preventing premature mortality (Target 3.4), the article references a report from the Correctional Association of New York, noting that “suicides in prison more than doubled from 2023 to 2024.” This is a stark and measurable indicator of the severity of the mental health crisis and the failure of the current system.

3. Recidivism Rates

   • The article implies that recidivism rates are an indicator of the system’s ineffectiveness (Target 16.6). It states, “We know untreated mental illness drives higher recidivism rates.” Therefore, tracking the recidivism rates of individuals with mental health conditions who leave prison could serve as an indicator of whether the institution is effectively providing rehabilitative care.

4. Institutional Spending vs. Outcomes

   • The article points to a financial indicator of institutional ineffectiveness (Target 16.6) by contrasting high expenditure with poor results. It mentions, “New York spends more than $3 billion annually on prisons yet continues to ration care as if acknowledging suffering were too expensive.” This ratio of high spending to negative outcomes (like high recidivism and untreated illness) serves as an indicator of an inefficient and ineffective institution.

4. SDGs, Targets, and Indicators Table

Source: truthout.org